The modified Fontan procedure: physiology and anesthetic implications

Area of Science:

• Cardiology
• Pediatric Surgery
• Anesthesiology

Background:

• The modified Fontan operation is a widely accepted palliative procedure for complex congenital heart disease (CHD) with single ventricle physiology.
• This procedure allows most patients to achieve long-term survival and symptom palliation, leading to improved quality of life.
• A key physiological consequence is the absence of a pulmonary contractile ventricle, necessitating a single ventricle to support both pulmonary and systemic circulations.

Purpose of the Study:

• To highlight the physiological implications of the modified Fontan operation.
• To underscore the impact of systemic venous hypertension on anesthetic and postoperative management.
• To inform healthcare providers about critical care considerations for these unique patients.

Main Methods:

• Review of physiological principles underlying the modified Fontan circulation.
• Analysis of the consequences of elevated systemic venous pressure.
• Discussion of anesthetic and postoperative care strategies.

Main Results:

• The single ventricle must perfuse both circulations, requiring elevated systemic venous pressure.
• This elevated pressure leads to systemic venous hypertension.
• Systemic venous hypertension significantly influences anesthetic and postoperative care requirements.

Conclusions:

• The modified Fontan operation provides excellent long-term palliation for single ventricle physiology.
• Systemic venous hypertension is an inherent consequence of this surgical approach.
• Anesthetic and postoperative management must carefully address the challenges posed by systemic venous hypertension.